Monday, August 31, 2015

y name is Dr. Jacqueline Harvey and I write today to share new and vital evidence from my latest study, "Assisted Suicide: Political Risks and Rewards for Legislators Associated with Votes to Legalize vs. Maintain the Status Quo" that will help inform your vote on ABX2-15. This paper was submitted for the 2016 Western Political Science Association in San Diego and is the first analysis of the political risks and rewards for lawmakers attributed to their vote for or against assisted suicide. It examines the fate of lawmakers in Vermont who passed the first and only assisted suicide bill Act 39 in 2013. By contrasting each lawmakers vote on Act 39 with 2014 election results as well as the subsequent voting records on assisted suicide for each office, the study indicates that lawmakers who voted to monumentally change the status quo on an issue as contentious as assisted suicide faced confirmed risks with no rewards. Consider the following findings:

There was a statistically significant higher incidence of losing re-election attributed to a pro-assisted suicide vote (r=.176) but no risk/losses attributed to an anti-assisted vote.

Lawmakers who voted in favor of assisted suicide lost their re-election campaigns more than twice as often as those who chose to maintain the status quo, seven vs. three (n=10)

Voting against assisted suicide was not a factor that contributed to any of the 3 losses.

Voting in favor of assisted suicide was a factor in six out of seven failed campaigns, and was only ruled out in one case.

In every case where assisted suicide was a variable in re-election, 100% of those who lost re-election were in favor of assisted suicide.

In all six cases where assisted suicide was a factor, 100% of those who lost re-election were succeeded by legislators who voted to repeal Act 39.

Democrats comprised 100% of losses where assisted suicide was a factor and all were replaced by Republicans.

Neither party suffered a single loss due to a vote against Act 39, a total of 30 Democrats and 34 Republicans who voted against Act 39 and none of those who sought re-election lost to a pro-assisted suicide challenger.

Controlling for party-affiliation confirmed that there was no political benefit for voting in favor or opposed to Act 39. In the four out of ten cases where the candidates' position on assisted suicide was ruled out as a contributing factor in their loss, the two instances that include one vote in favor and one opposed both, which indicate voters did not choose a lawmaker over the challenger as a reward for their previous vote on assisted suicide.

The author of Act 39 was not rewarded with re-election for passing the first assisted suicide bill but unseated after six years in office by a candidate who voted to repeal Act 39.

The implications of these findings for you in regard to ABX2-15 is that the perceived support that passed Act 39 did not endure to the ballot box. Voters certainly do not reward their elected officials for supporting assisted suicide and potentially vote against them in retribution. Please consider this evidence when choosing if this issue, which already lacks public support, is worth the risks that you could face by offering your support.

According to a poll of 1,047 doctors by the Canadian Medical Association (CMA), released as part of the organization’s annual general meeting in Halifax, 63 per cent would refuse to provide so-called “medical aid in dying.” 29 per cent said they would consider killing a patient upon request, with 19 per cent saying that they “would be willing to help end the life of a patient whose suffering was psychological, not physical.”

The results suggest there remains strong opposition to assisted suicide among the membership of the CMA, which until recently was officially opposed to a loosening of anti-euthanasia laws in any form. At the same time, it suggests there are enough doctors willing to aid a patient to commit suicide to serve the demand. Unfortunately, that is not enough to settle the matter of just when and how physicians will be involved.

Put yourself in the position of a doctor who believes euthanasia to be a deep moral wrong. This is not an antiquated or otherwise-dismissible position. The legalization of physician-assisted suicide is a revolution in medicine, which turns the role of doctors as a provider of care on its head and intrudes upon the Hippocratic Oath’s instruction to “not play at God.” It violates the traditional conception of medicine, beseeching the physician to do no harm. It is a new and relatively unchartered territory — altogether so here in Canada. It is imperative that the conscience rights of all be protected.

Any doctor should have the right to say, “I want nothing to do with this.” While this would obviously not allow him or her to interfere in the decision of another doctor to help a patient commit suicide, the conscientiously objecting doctor should equally be under no obligation to abet the killing of a patient in any way, whether directly or by referral to another doctor.

The Supreme Court’s finding ... means there are limits on how far Parliament can restrict the practice. It does not — and should not — imply an obligation upon all doctors to participate in the new assisted-suicide regime.

The National Post ends the editorial by urging parliament to recognize conscience rights.

As the CMA poll suggests, there remains considerable hesitation on the part of Canada’s physicians to jump on the euthanasia bandwagon. Accordingly, Parliament’s new law should be explicit in affording the utmost protection to doctors who do not wish to participate in this new and morally troubling enterprise.

The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, the only way to protect people is by protecting the conscience rights of physicians.

When physicians have the right to say - I will not kill you - then they also have the right to say - I will protect you in your time of need.

Wednesday, August 26, 2015

The Canadian Medical Association (CMA) voted to reject a motion to protect the conscience rights of physicians who refuse to refer patients to die by euthanasia at their annual General Council meeting today in Halifax. Physicians who oppose euthanasia are attempting to achieve a reasonable compromise.A media release from the CMA today stated:

Conscientious objection was a contentious issue, with 71% of delegates voting against a motion to support conscientious objectors who refuse to refer patients for medical aid in dying.

"What we expect from physicians, at a minimum, is that they provide further information to patients on all the options including the spectrum of end-of-life care and … how to access those services," CMA Vice President of Medical Professionalism Dr. Jeff Blackmer told reporters at a press conference Aug. 26.

Yesterday, the CMA released the data from an online consultation of 1407 members which found that 63% would refuse to assist the death of their patients, 29% would assisted the death of their patients upon request and 8% were unsure.But only 29% of the physicians who would refuse to lethally inject their patients would also refuse to refer patients to their death.

The family of a man, who died by suicide are challenging their father's Will that gave $1.8 million to Philip Nitschke and his euthanasia lobby group, Exit International.

According to the Herald Sun William O’Brien’s children Gai and Brett challenged the 89-year-old’s will after he took his own life last year. The Herald Sun reported Philip Nitschke, the founder of Exit International, as saying:

Mr O’Brien believed that every elderly person, terminally ill or not, should have that choice.

the legal challenge was “very surprising” given Mr O’Brien felt that he had provided for his children “very adequately”, and the directions for his estate should be respected by the court.

According to the Herald Sun Mr O'Brien died in July 2014 even though he was reportedly in good health. The Herald Sun also reported that O'Brien left $5000 to each of his surviving children.

Dying With Dignity Canada received almost 24% of their income in 2014 from bequests.

Tuesday, August 25, 2015

Today, the Canadian Medical Association (CMA) released to the media the results of their online survey of members. The survey that was based on responses from 1407 CMA members found that 63% would refuse to assist the death of their patients, 29% said that they would assisted the death of their patients upon request and 8% were unsure.

For those who would assist the death of their patients, 43% would do so for non-terminal patients and 19% would do so for patients who live with psychological suffering.The Supreme Court of Canada decision defined Assisted Death to include euthanasia (lethal injection) and assisted suicide (prescribing a lethal dose).

"I feel strongly that hastening death is not part of medicine. I think it eviscerates what medicine is intended to be. I think that asking physicians to be killers is contrary to the very core of medicine,"

Physicians conscience rights.

According to the Globe and Mail, 75% of the CMA conference delegates agreed that:

physicians should provide information to patients on all end-of-life options available to them but should not be obliged to refer.

The Globe and Mail article quoted Dr. Jennifer Tong of Vancouver who warned:

“coercing physicians against their conscience” would damage patient-doctor relations and push some out of the profession.

Dr. Jeff Blackmer, vice president of medical professionalism with the CMA stated:

"No physician should be forced to participate against their conscience,"

"But there's disagreement about what this means."

29% of the physicians who refuse to kill their patients are also opposed to having anything to do with assisted death, while the others were either unsure or willing to refer their patient to another physician or administrator in some manner.

The Euthanasia Prevention Coalition recognizes that if euthanasia and assisted suicide become legal, that the only way to protect people is by protecting the conscience rights of physicians.

When physicians have the right to say - I will not kill you- then they also have the right to say -I will protect you in your time of need.

Euthanasia was last debated in Tasmania on the 17th of October 2013 when the Voluntary Assisted Dying Bill was defeated 13 votes to 11 in the State's Lower House. Since that time, the State Election has changed the make up of the chamber offering, perhaps, the mover of the last bill, Lara Giddings MP, some hope that this time the outcome might be different.

The ALP motion - now part of the party's Tasmanian platform - is subject to the normal provision of a conscience vote and is, we understand, not binding upon State ALP Members of Parliament.

However, as noted in The Examiner, the three new members on the government benches for the Liberal Party are holding their cards close and claiming, at this time, to be 'openminded' on the subject.

Readers should note that, in 2013, Lara Giddings was Premier which provided her with additional control over the debate process. This time around she is a Shadow Minister on the opposition benches.

Time will tell. The Examiner reports that Lara Giddings will be looking to introduce her bill later this year.

While the federal election campaign is in full swing, the question of Euthanasia is beginning to make its way among major election issues in healthcare. Indeed, the next federal government will have the mandate to enact a law before February 6 in response to the Supreme Court’s judgment on "medical assistance in dying."

Composed of 11 provinces and territories, this new advisory group, led by Ontario, will too be responsible for providing advices on the development of policies, practices and protective measures to be taken with the legalization of assisted suicide on their respective territories. Several experts are featuring on its board, namely Maureen Taylor, Jocelyn Downie and Arthur Schaefer are well known pro-Euthanasia activists.

We also strongly encourage you to take advantage of this key moment in our democracy to contact your candidates and discuss with them about issues regarding Euthanasia and assisted suicide, in particular their social impact on families and caregivers and the measures to be taken to protect vulnerable people.

Living with Dignity, the Physicians’ Alliance against Euthanasia and the Euthanasia Prevention Coalition are stressing the importance of expressing yourself in the polls, especially during electoral period. By doing so, you add weight to the experts’ recommendations in order to contain the excesses that the law on Euthanasia and assisted suicide will generate in a few months.

During the trial, prosecutors argued that the group gave Doreen Dunn, of Apple Valley, a “blueprint” for ending her life and made efforts to conceal her suicide from family and authorities by removing the equipment she used.

Criminal cases against Final Exit Network coordinator Roberta Massey, of Bear, Del., and the group’s medical director, Lawrence Egbert, 87, of Baltimore, are still pending.

Another defendant, Jerry Dincin, died and charges against Thomas Goodwin were dismissed in 2013.

Dakota County prosecutor Elizabeth Swank told jurors that the evidence showed that two members of Final Exit Network went to Dunn's home in Apple Valley to assist her suicide. They then removed the equipment that she used for suicide so that it appeared she had died of natural causes.

Dunn's husband of 29 years arrived home on May 30, 2007, to find her dead on the couch. Swank said Dunn had a blanket pulled up to her neck with her hands folded on her chest.

Swank said that despite Dunn's pain and depression, she had no life-threatening illness and her family was puzzled by her death. There were good things happening in her life: Her daughter who had been in Africa for about a year was coming home the next day and her son's fiancee was scheduled to give birth that week. However, her husband was also planning to move out, the prosecutor said.

John Celmer

Judge Christian Wilton senteced FEN to the maximum sentence by ordering that they pay a $30,000 fine plus $3000 towards the funeral cost.

FEN has been prosecuted for assisting several suicides. In Georgia, John Celmer, who was depressed after recovering from cancer, died after FEN assisted his suicide. Celmer's widow Susan Celmer, testified against FEN.

The Washington Post published a very well researched article by Charles Lane on August 19, 2015 titled: Europe's sinister expansion of euthanasia. This same article was republished in the National Post and several other major newspapers.

Lane examined the date from the recent research concerning the Belgian euthanasia law. I have written similar articles, but to his credit, Lane has been published by major newspapers.

Between October 2007 and December 2011, 100 people went to a clinic in Belgium’s Dutch-speaking region with depression, or schizophrenia, or, in several cases, Asperger’s syndrome, seeking euthanasia. The doctors, satisfied that 48 of the patients were in earnest, and that their conditions were “untreatable” and “unbearable,” offered them lethal injection; 35 went through with it.

These facts come not from a police report but an article by one of the clinic’s psychiatrists, Lieve Thienpont, in the British journal BMJ Open. All was perfectly legal under Belgium’s 2002 euthanasia statute, which applies not only to terminal physical illness, still the vast majority of cases, but also to an apparently growing minority of psychological ones. Official figures show nine cases of euthanasia due to “neuropsychiatric” disorders in the two-year period 2004-2005; in 2012-2013, the number had risen to 120, or 4 percent of the total.

... the Netherlands, which decriminalized euthanasia in 2002, right-to-die activists opened a clinic in March 2012 to “help” people turned down for lethal injections by their regular physicians. In the next 12 months, the clinic approved euthanasia for six psychiatric patients, plus 11 people whose only recorded complaint was being “tired of living,” according to a report in the Aug. 10 issue of JAMA Internal Medicine.

If you find this sinister, I agree. Bioethicists Barron H. Lerner and Arthur L. Caplan, who reviewed the data from the Low Countries in JAMA Internal Medicine, observe that the reports “seem to validate concerns about where these practices might lead.”\

Lane emphasizes that the Belgian study admits that decisions for euthanasia are based on undefined criteria:

Thienpont acknowledges that “the concept of ‘unbearable suffering’ has not yet been defined adequately” and that “there are no guidelines for the management of euthanasia requests on grounds of mental suffering in Belgium.”

Yet she and her colleagues continue to put the mentally ill to death, insisting that they are respecting their wishes — though, as she writes, “further studies are recommended.”

Frank van den Bleeken

Lane then uses the example of Frank van den Bleeken, the Belgian prisoner who was serving a life sentence for murdering and raping. van den Bleeken was approved for lethal injection for reasons of psychological suffering because he considered living in prison for the rest of his life was too great a level of suffering. Lane states:

Thienpont’s co-author Wim Distelmans, a leading advocate of euthanasia, has ended the life of a 44-year-old who was anguished, but not terminally ill, due to a botched sex-change operation. Distelmans also put to death identical 45-year-old deaf twins who said they lost the will to live upon learning they would eventually go blind.

Frank van den Bleeken, imprisoned for 30 years for rape and murder, sought euthanasia from Distelmans, citing his incurable violent impulses and the misery of life behind bars. Belgian officials and Distelmans initially agreed; a lethal injection the murderer might have gotten as punishment in the United States would be supplied as therapy in anti-death penalty Europe.

Distelmans faced little accountability either way. The body empowered to scrutinize his actions, after the fact, was Belgium’s Euthanasia Control and Evaluation Commission — of which he is co-chairman. It has reviewed thousands of cases since 2002 but referred exactly none to law enforcement.

Lane ends the article by quoting from the Lerner and Caplan commentary:

The “very worrisome” trends in Europe “should give us pause” about where the “assisted dying” movement might lead in this country, Lerner and Caplan write.

To be sure, by authorizing doctors to administer lethal drugs, in terminal and non-terminal cases, the Benelux countries go far beyond laws in Oregon and four other states, which permit physicians to prescribe, not administer, a fatal dose — and only in cases of terminal physical illness.

Charles Lane has done his homework. Euthanasia has gone through multiple extensions. The types of euthanasia deaths that are happening in the Netherlands and Belgium would have been considered abuses of the law, if they had occured in the first years.

Friday, August 21, 2015

A doctor who is reluctant to perform an assisted suicide but refers a patient to someone else prepared to do it, is on the same moral ground as a doctor who willingly participates.

The Supreme Court of Canada’s decision in February which struck down the ban on euthanasia prompted the Conservative government to form a commission on euthanasia last month.

One of the issues under debate is whether doctors should be compelled to perform assisted suicides on terminally ill patients.

In fact, it is absolutely crucial to determine who can influence the decision of carrying out a physician-assisted suicide.

The ethical and legal issues are complex.

Even deciding on a useful definition of “terminally ill” is a minefield, and that’s just the start.

Medical diagnosis and prognosis are inexact sciences, and mistakes in them often occur in Canada’s healthcare system.

Quebec’s Bill 52 right-to-die legislation, which has already passed, has been interpreted to mean the following:

To qualify as a terminal illness it must be incurable and serious; it must have caused an advanced and irreversible decline in bodily function; the person requesting the procedure must be in unbearable and constant pain, both physical and mental; the patient must be an adult, mentally sound enough to give credible consent.

As an extra safeguard, Quebec requires doctors and patients to get second opinions.

An independent commission composed of doctors, jurists, ethicists and ordinary citizens will oversee the process for reaching such decisions.

All the ground work seems to have been covered here.Suitable patients will be only those who are the truly terminally ill and anguished patients who can no longer live with their situation.

Given this, it almost seems humane to grant their wish of dying with dignity.

But do measures like this adequately address the concerns of doctors who object?

The large number of Canadian physicians reluctant to perform assisted suicides throws doubt on the practicality of such a policy.

Prominent Quebec bioethicist David Roy has noted that: “Killing the pain is the point, not killing the patient.”

He has also asked: “Should we socially and legally (put) this power to administer death to patients into the hands of physicians, who are relatively inept at communicating with suffering and dying people?”

I have stated the reasons for my unease about euthanasia previously.

My biggest concern is that suicide is self-evidently an irreversible decision for a patient to make.

Medical advances that could directly impact on a patient’s decision to take his or her life may be unlikely, but they are possible.

A disease that is “incurable” today may have a breakthrough in treatment tomorrow.

Recently, for example, researchers at Thomas Jefferson University discovered that blocking certain types of proteins in the brain may allow them to administer drugs that can inhibit Lou Gehrig’s disease (ALS) a debilitating illness.

It is hard to imagine an issue more likely to provoke polarized and heated arguments than euthanasia.

Any law which tries to define its limits will face challenges not just from doctors, who are on the front lines of medical care, but from all sections of society.

The debate is much wider than the example of any single case.

No law is likely to be fair and comprehensive enough that it will address all concerns about allowing euthanasia as one humane option in genuinely dire cases.

The case argued that "aid in dying", which is also known as assisted suicide, is not prohibited by the New Mexico assisted suicide law because "aid in dying" is not assisted suicide.

The case argued, that if "aid in dying" is assisted suicide, then the New Mexico assisted suicide law is unconstitutional because it undermines the right to privacy and autonomy.

But, Aid in dying is assisted suicide and assisted suicide does not constitute medical treatment. Therefore prohibiting assisted suicide does not undermine the right to privacy or autonomy.

The case originally concerned Aja Riggs, a woman with uterine cancer, who said that she wanted to die by assisted suicide, and two doctors who were willing to prescribe lethal drugs. Riggs told the Albuqueque journal last December that she is now in remission. She is fortunate that the court did not give her an exemption to die by assisted suicide.

Since Riggs is in remission, the suicide lobby amended their claim. Now the case is based on Susan Brown, who has terminal cancer and David Bradley, who lives with ALS.

Sean Murphy, the administrator of the Conscience Protection Project wrote an excellent article that was published by the National Post on August 20, 2015. In his article: Turning physicians into executioners, Murphy informs readers that the Canadian Medical Association (CMA) are debating the physicians role in euthanasia and assisted suicide at their annual meeting in Halifax next week.

Murphy quotes Dr Jeff Blackmer, the former ethicist with the CMA who called the legalization of assisted suicide the:

biggest change in the medical profession in Canada, maybe in centuries

One person’s right is another person’s obligation, and sometimes great burden, they wrote. And in this case, a patient’s right to assisted dying becomes the physician’s obligation to take that patient’s life.

Murphy then focuses on what an obligation to take a patient's life actually means.

An obligation to kill is distinct from authority to use potentially deadly force; neither police nor soldiers are obliged to kill. Traditionally, an obligation to kill has been imposed only on public executioners, its essence captured by Blackstone’s explanation that if the condemned were not killed by hanging, the sheriff would have to hang him again.

CMA leaders at Supreme Court

Murphy provides an update as to how the CMA changed its policy from opposing assisted suicide to that of regulating assisted suicide.

At the CMA’s 2014 General Council, delegates learned that almost 27 per cent of Canadian physicians were willing to participate in assisted suicide if it were legalized — and 73 per cent were not. This was urged as a reason to adopt a policy of neutrality. The board of directors helpfully sponsored a resolution affirming that, should the law change, the CMA would support physicians who follow their conscience in either providing or refusing to provide medical aid in dying. It was overwhelmingly approved.

Four months later, the board, citing the resolution, reversed CMA policy by declaring physician-assisted suicide and euthanasia to be end-of-life care. The new policy did not exclude minors, the incompetent or the mentally ill, nor did it suggest restricting euthanasia and assisted suicide to terminally ill patients or those experiencing uncontrollable suffering.

The board’s Christmas present for the Supreme Court of Canada was a blank cheque. It offered the unconditional support of the medical profession for the legalization of euthanasia and assisted suicide for any patient group, for any reason and under any conditions approved by the courts or legislatures.

Murphy then examines the issue of conscience rights:

What about those ... physicians who utterly reject the claim that physicians are ever obliged to participate in euthanasia or assisted suicide?

The policy states that they should not be compelled to do so, but adds that there should be no undue delay in providing the services. That is: conscientious objection is allowed only to the extent that it does not interfere with the obligation to kill, more felicitously phrased from the patient perspective as access to services.

The priority of killing over conscience was a consequence of the board’s decision to adopt a partisan rather than neutral position on medical aid in dying. By accepting the morally contested obligation to kill as normative, CMA directors imposed a paradigm for medical practice and a framework for discussion that’s inherently prejudiced against physicians unwilling to participate in euthanasia and assisted suicide. ...

In March, the board declared that all Canadians who meet the criteria should have access to assisted dying, as with any other medically approved intervention. This was accompanied by strong statements supporting conscientious objection, including refusal to refer for the services.

By June, these foundational principles had been rewritten to give priority to the obligation to kill at the expense of freedom of conscience. They were incorporated into a draft framework for consultation and presentation at the General Council in Halifax.

The draft framework proposes that objecting physicians be made to work with others to support equitable and timely access to euthanasia and assisted suicide. ...

The framework supports conscientious objection, but only to providing euthanasia and assisted suicide, only if refusal does not cause undue delay and only if the physician refers the patient to a third party for assistance and information — whatever that might mean.

It is abundantly clear that CMA officials favour some form of compulsory referral, not only because they offer no other options, but because their draft framework is erroneous, incomplete and misleading — sometimes seriously so — and every error, omission and misleading statement favours referral.

Last year, CMA delegates approved a resolution said to be neutral with respect to euthanasia and assisted suicide, which the CMA’s board cited when it approved both and made an obligation to kill part of medical practice.

This year, delegates will be asked to approve some form of compulsory referral as a middle ground between this contested obligation to kill and freedom of conscience. What is presented as pragmatic middle ground is really an ethical quagmire.

The Euthanasia Prevention Coalition is wants the CMA to reject their support for euthanasia while recognizing physicians conscience rights.

The new bill, AB 15, is in substance an old bill (SB 128) that was unable to make it out of committee.

AB 15 has some new provisions and puts some of the old bill's provisions in a different order. AB 15 is in substance the same bill as the old bill. Key points include:

AB 15 applies to patients with a "terminal disease." In Oregon, which has a similar law, such persons include young adults with chronic conditions such as insulin dependent diabetes and chronic lower respiratory disease. People living with HIV/AIDS, who are dependent on their medication to live, also qualify as "terminal." Such persons can have years, even decades, to live.

Once a person is "labeled 'terminal,' an easy justification can be made that his or her treatment or coverage should be denied in favor of someone more deserving."[1] In Oregon, where assisted suicide is legal, patients are not only denied coverage for treatment, they are offered assisted suicide instead.[2] Well known cases are Barbara Wagner and Randy Stroup.[3]

The bill remains a recipe for elder abuse in which the patient's heir, who will financially benefit from his or her death, is allowed to actively participate in signing the patient up for the lethal dose. This fact alone does not meet the "stink test."

Once the lethal dose is issued by the pharmacy, there is no oversight. Not even a witness is required at the death. If the patient struggled, who would know?

The death certificate is required to be falsified to reflect a natural death. The significance is a lack of transparency and an inability to prosecute for murder even in a case of outright murder for the money.

Having lost fair and square in a California Assembly Committee, the suicide pushers have filed a new legalization bill–AB 15–for a special session intended to grapple with health care costs.Assisted suicide advocacy is about lying. Catch this bit of mendacity from the bill: Aid-in-dying drug” means a drug determined and prescribed by a physician for a qualified individual, which the qualified individual may choose to self-administer to bring about his or her death due to a terminal disease.

No. The death would not be from any disease, but a lethal dose of drugs.The committee has been re-jiggered to take the “no” votes away, I am told. Can we say, stacked deck?And the bill is on a very fast track. Can’t give people time to think or understand why assisted suicide is bad medicine and even worse public policy.If this shameful machination works, I hope Jerry Brown remembers his service to the dying with Mother Theresa. She is definitely spinning in her grave.

As a physician in Oregon, I have seen the dire effect of assisted-suicide laws on patients and my profession.

William Toffler

By Dr William Toffler

Since the voters of Oregon narrowly legalized physician-assisted suicide 20 years ago, there has been a profound shift in attitude toward medical care—new fear and secrecy, and a fixation on death. Well over 850 people have taken their lives by ingesting massive overdoses of barbiturates prescribed under the law. Proponents claim the system is working well with no problems. This is not true.

As a professor of family medicine at Oregon Health & Science University in Portland, as well as a licensed physician for 35 years, I have seen firsthand how the law has changed the relationship between doctors and patients, some of whom now fear that they are being steered toward assisted suicide.

In one case a patient with bladder cancer contacted me. She was concerned that an oncologist treating her might be one of the “death doctors,” and she questioned his motives. This was particularly worrying to her after she obtained a second opinion from another oncologist who was more positive about her prognosis and treatment options. Whichever of the consultants was correct, such fears were never an issue before.

Under Oregon’s law, a patient can request lethal drugs only if he has a terminal illness and less than six months to live. However, it is nearly impossible to predict the course of an illness six months out, and many patients given such prognoses live full, rewarding lives long past six months.

The law requires that patients be referred for psychological examination if the doctor suspects they have depression or mental illness. But some doctors see suicide as a solution to suffering and depression as rational given patients’ circumstances. Last year only three of the 105 patients who died under the law were referred for a psychological exam.

A 2008 study published in the British Medical Journal examined 58 Oregonians who sought information on assisted suicide. Of them, 26% met the criteria for depressive disorder, and 22% for anxiety disorder. Three of the depressed individuals received and ingested the lethal drugs, dying within two months of being interviewed. The study’s authors concluded that Oregon’s law “may not adequately protect all mentally ill patients.”

Also concerning are the regular notices I receive indicating that many important services and drugs for my patients—even some pain medications—will not be covered by the Oregon Health Plan, the state’s Medicaid program. Yet physician-assisted suicide is covered by the state and our collective tax dollars. Supporters claim physician-assisted suicide gives patients choice, but what sort of a choice is it when life is expensive but death is free?

A shroud of secrecy envelops the practice of assisted suicide. Doctors engaging in it do not accurately report the actual manner of death. Instead they are required by state law to fabricate the death certificate, stating that the cause is “natural” rather than suicide. In late 1997, right before assisted suicide was about to begin, the state legislature implemented a system of two different death certificates—one that is public and includes no medical information and another that is kept private by the state. As a result, no one outside of the Oregon Health Division knows precisely how many assisted suicides have taken place, because accurately tracking them has been made impossible.

In my practice, more than two dozen patients have discussed assisted suicide with me. Most did not have a terminal diagnosis. One inquiry came from a patient with a progressive form of multiple sclerosis. He was in a wheelchair yet lived an active life as a general contractor. I asked him how the disease affected his life. He acknowledged that MS was a major challenge and told me that if he got too much worse, he might want to “just end it.”

I told him I could understand his fear and frustration and even his belief that assisted suicide might be a good option. I also told him that should he become sicker or weaker, I would work to provide him the best care and support available. No matter how debilitated he might become, his life was, and would always be, inherently valuable. As such, I said that would I not recommend nor would I participate in his suicide. He simply replied: “Thank you.”

The way that physicians respond to patients’ requests for lethal drugs has a profound effect on their choices and their view of themselves and their inherent worth. Such patients deserve doctors who will support them through their illnesses, not offer them a quick exit.

One of the most troubling notions I hear is that killing oneself with sleeping pills is “dignified”—as if natural deaths aren’t. Last year my wife, Marlene, died of metastatic cancer. We’d been married for 40 years. The final five years we both knew she would inevitably die of her cancer. At one point doctors told her that she had only three to nine months left, yet she lived more than four times as long.

The following article was published by on August 18 by Advocate Daily.

Hugh Scher

The formation of an advisory group representing Canada's provinces and territories on physician-assisted suicide is premature given that a federal panel appointed to lead efforts in addressing the Supreme Court of Canada’s lifting of the prohibition against it has yet to report its findings, says Toronto health and human rights lawyer Hugh Scher.

“We are still awaiting the results of the federal panel and the federal government’s actions in response to the Supreme Court’s decision in Carter,” says Scher, referring to Carter v. Canada (Attorney General), 2015 SCC 5. “Until we understand what the scope and nature of the federal government response is, it is difficult for the provincial governments to concretely look into issues that may be relevant for them to consider.”

In February, the Supreme Court struck down the Criminal Code prohibitions that ban physician-assisted suicide in certain express circumstances and gave Parliament one year to legislate new rules to give effect to the ruling. The federal government then established an external panel to inform its legislative response to the high court’s decision.

Now, Ontario’s provincial government has announced it will lead an advisory group representing the country’s provinces and territories to complement the work of the federal panel.

“As provinces and territories have the primary responsibility to provide health care, including regulating physicians and health-care facilities, they will consider whether regulatory or other changes are needed over the coming months in response to the Supreme Court's decision,” says a government news release. “The advisory group will provide advice on the development of policies, practices and safeguards for provinces and territories to consider when physician-assisted dying is legal within their respective jurisdictions.”

But Scher, a well-known voice in the end-of-life care debate, says the issue of assisted suicide has historically fallen to the government at the federal – not provincial – level.

“The Carter decision said there ought to be an exception carved out of the general prohibition against assisted suicide based on tailored exemptions spelled out by the Supreme Court, but nevertheless the federal government continues to maintain jurisdiction over the regulation of assisted suicide,” he says.

“The notion that euthanasia and assisted suicide are somehow considered health care, falling under the provincial government’s jurisdiction is problematic and likely unconstitutional, notes Scher.

While provincial governments may eventually want to implement plans to adhere to the federal regime, Scher says it is premature for such considerations.

The composition of the advisory group is also concerning, particularly given its mandate, as many have a “clear and express record of advocacy of assisted suicide and euthanasia,” says Scher.

The group is to be co-chaired by Dr. Jennifer Gibson, director of the University of Toronto Joint Centre for Bioethics, and Maureen Taylor, medical journalist and wife of the late Donald Low, says the news release.

“It seems that the panel is a stacked deck,” says Scher, who notes he’d like to see representation from provincial medical associations, for example. “I’m particularly concerned that the panel not wade into constitutionally uncertain territory in light of the ongoing federal jurisdiction over assisted suicide.

“It seems to me the appointment of the provincial committee is in large measure an intentional reaction to the formation of the federal government panel put in place, in an effort by the right to die community, aided by the governments, to effectively negate or otherwise offset any recommendations that may come out of the federal government’s panel on the issue,” says Scher.